Preganancy Flashcards
Langauge
Can be gender based, but be aware of your own biases
use non-gendered language when possible
be aware of gender dysphoria (chestfeeding instead of breastfeeding)
Preconception Assessment
Would you like to have a child in the next year?
Assess BMI, reproductive history
family history of genetic disorders
Past med/surgical history
current meds
vaccinations
scree for STIs, pap smear
Psychosocial
Preconception teaching
healthy diet and exercise
avoid alcohol, tobacco and drugs
discuss occupation and enviornmental risk
folic acid supplement at leat 3 months prior to conception
dental care (risk of preterm birth with poor oral health)
Trying to concieve?
Avg. menstrual cycle is 28 days
First 14 days the egg matures in follicle (FSH hormone), then the luteinizing hormone triggers the egg release (LH)
then there is a 12-24 hour window for the sperm to fertilize egg
Sperm can survive up to 3 days after intercourse in the genital tract
Placenta
produces 4 hormones to maintain pregnancy and support for embryo and fetus
Human chriorionic
ganadotropin
Human placental lactogen (hPL)
Progesterone and estrogen
Signs of pregnancy
presumptive-experienced by women
amennorhea, nausea, fatigue, breast tenderness
Probable-detected by examiner (enlarged uterus)
Positive-objective evidence of fetus-auscultation of fetal heart tones and ultrasound
Nagele’s rule
determined gestational age
expected date of delivery
a typical pregnancy lasts 40 weeks
(starts with the first day of the last menstrual period as day 1) add 9 months and 7 days
Ultrasound dating very early in pregnancy
accurate very early in pregnancy
transvaginal early
transabdominal later
Trimesters
1st Weeks 1-12
2nd Weeks 13-27
3rd Weeks 28 to birth
Gravidity
Pregnancy
Gravida
Client who is pregnant
Primigravida
Pregnant for the first time
Multigravida
Client who has had 2 or more pregnancies
Nulligravida
Client who has never been pregnant
GTPAL
Ontario perinatal record
insludes gravida (total # of pregnancies regardless)
Term (# of pregnancies with birth at greater than 37 weeks
Preterm (# of previous pregnancies with birth between 20 and 37 weeks)
Abortus (number of abortions prior to 20 weeks
Living children (number of living kids currently)
Gravida
Number of current or past pregnancies regardless of outcomes
Term
of previous pregnancies with birth after 37 weeks
Preterm
Previous pregnancies with birth occurring between 20 and 36 and 6 days
Abortus
Number of pregnancies ending with birth before 20 weeks
Living children
how many kids are currently living
First trimester changes
hormones produce changes
nausea and vomitting, fatigue
uterus changes in size and shape
fetal heart tones
2nd semester changes
quickening and palpable fetal movement
breast enlargement and colostrum(thick pre milk)
linea nigra (line to top of uterus) and striae gravidarum (stretch marks)
thyroid gland and hormones
gingivitis
fetal heart tones (120-160 is normal for baby)
blood pressure
gastro changes (heartburn, changes in cravings)
Eclampsia from too high of blood pressure
third trimester changes
blood volume and components
urterine enlargements
edema of lower extremities
posture and lordosis
varicosities and hemmorrhoids
engagement
lightening (dropping of stomach), mucus plug exposure
Weight gain during pregnancy
depends on the BMI to start
higher BMI should not gain as much weight
25% is the fetus
11% is placenta
62% water gain and 30% fat gain and 8% protein
Prenatal nutrition
determinants of health have impact on dietary intake
good nutrition before and during pregnancy is important
does mom have access and financial access to food
inadequate nutrition can lead to low birth weight and preterm babies
Developmental considerations
decreasing rate of adolescent pregnancy
teen pregnancy risk in rural areas, socioeconomic groups, little family support, limited prenatal care and aboriginal communities
risk for pre-eclampsia-inadequate nutrition, substance use, stis, poverty
advanced maternal age in Canada-increase in down syndrome, increased risk for multiple fetuses, co existing medical conditions
Cultural and Social Considerations
some complications of pregnancy more frequent in specific populations
complex mix of hereditary and genetic factors
subjective data
menstrual history-first day of normal menstrual period
gynecological history-uterus or cervical surgery
obstetrical history-GTPAL
current pregnancy-calculate weeks of gestation
Medical history-allergies, asthma
Health history questions
family history
review of systems
nutritional history
enviornmental hazards
bloooood pressssure history
Objective Exam
Prep-equipment-stethescope, blood pressure cuff(every visit), centimetre measuring tape(fundal height every visit), fetosocpe and doppler(on fetus) sonometer
pelvic exam maybe beginning and end
reflex hammer (check if bp is high)
urine collection container (check for utis and protein)
urinaysis test strips
equipment for pelvic exam
General survey
skin-chloasma-redness in mask shape
linea nigra
striae
mouth, neck(throid-don’t want hyperthyriodism)
breasts-size and pigmentation
heart (murmur is possible)
lungs
peripheral vascular (edema in legs, varicose veins, DVT (increased estrogen might cause this)
Physical exam neuro and abdomen
neuro-deep tendon reflexes
abdomen-shape and contour
palpate fundus and measure height
palpate uterine contractions
leopold’smmanoevres fetal lie and presentation
Fundal height
measure at weeks of gestation
empty bladder prior to assessment
distance from symphysis pubis to top of uterus
measured in cm
gestation-week18=gastational age
Fetal heart tones
auscultate
count fetal heart rate
FHR x 1 minute=110-160
(make sure it not materal heart rate)
BLOOD PRESSURE
avoid eclampsia
